Johnson R A, Harper N J
Department of Anaesthesia, Manchester Royal Infirmary.
Br J Anaesth. 1989 May;62(5):483-7. doi: 10.1093/bja/62.5.483.
We have studied the influence of a reduced dose of neostigmine on recovery from vecuronium-induced neuromuscular block in 26 adult patients, using electromyographic responses to train-of-four (TOF) stimulation. Neostigmine 10, 20 or 40 micrograms kg-1 was administered when the first response had recovered spontaneously to 5-10% or 40-50% of control. Antagonism was accepted as adequate when the first response reached 90% of control and the TOF ratio reached 0.7. At both degrees of spontaneous recovery, neostigmine 40 micrograms kg-1 evoked the most rapid antagonism. Clinical recovery was satisfactory with no differences between groups. Block produced by neostigmine was not observed. The pattern of recovery of the single response and the TOF ratio was not altered by neostigmine in the range of doses studied. We suggest that the dose of neostigmine should not be reduced below 40 micrograms kg-1 even when all responses of the TOF are present.
我们利用四个成串刺激（TOF）的肌电图反应，研究了低剂量新斯的明对26例成年患者维库溴铵诱导的神经肌肉阻滞恢复的影响。当首次反应自发恢复至对照值的5%-10%或40%-50%时，分别给予10、20或40微克/千克的新斯的明。当首次反应达到对照值的90%且TOF比值达到0.7时，拮抗作用被认为充分。在两种自发恢复程度下，40微克/千克的新斯的明引起的拮抗作用最快。临床恢复情况良好，各组之间无差异。未观察到新斯的明产生的阻滞作用。在所研究的剂量范围内，新斯的明未改变单次反应和TOF比值的恢复模式。我们建议，即使TOF的所有反应均存在，新斯的明的剂量也不应降至40微克/千克以下。
